We undertook a focused inspection of Abbey Dental Care on 20 March 2019. This inspection was carried out to review in detail the actions taken by the registered provider to improve the quality of care and to confirm that the practice was now meeting legal requirements.

The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

We undertook a comprehensive inspection of Abbey Dental Care on 14 November 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We found the registered provider was not providing safe and well led care and was in breach of regulations 12 (Safe Care and Treatment) and 17 (Good Governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can read our report of that inspection by selecting the 'all reports' link for 14 November 2018 on our website www.cqc.org.uk.

As part of this inspection we asked:

• Is it safe?

• Is it well-led?

When one or more of the five questions are not met we require the service to make improvements and send us an action plan We then inspect again after a reasonable interval, focusing on the area where improvement was required.

Our findings were:

Are services safe?

We found this practice was providing safe care in accordance with the relevant regulations.

The provider had made improvements in relation to the regulatory breaches we found at our inspection on 14 November 2018.

Are services well-led?

We found this practice was not providing well-led care in accordance with the relevant regulations.

The provider had made insufficient improvements in relation to the regulatory breaches we found at our inspection on 14 November 2018.

Background

Abbey Dental Care is in Glastonbury, Somerset and provides private treatment for adults and children.

The dental team includes the principal dentist, an associate dentist, one trainee dental nurse, one dental hygienist, two receptionists and a practice manager. The practice has two treatment rooms.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

During the inspection we spoke with the principal dentist, the trainee dental nurse and the receptionist. We looked at some of the practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Wednesday 8am-6pm

Thursday 9am-6pm

Friday 8am-4pm

Our key findings were:

• The practice was providing care and treatment in a safe way to patients.
• Staff knew how to deal with emergencies. Appropriate medicines and life-saving equipment were available.
• The practice had infection control procedures which mostly reflected published guidance. The storage of instruments required improvement.
• Recruitment procedures required improvement.
• The practice had not implemented effective systems and processes to ensure good governance in accordance with the fundamental standards of care.
• The practice had inadequate systems to help them manage risk to patients and staff.

We identified regulations the provider was not complying with. They must:

• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulation the provider was not meeting are at the end of this report.

There were areas where the provider could make improvements. They should:

• Review the practice’s protocols for ensuring that all clinical staff have adequate immunity for vaccine preventable infectious diseases.
• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued by the Medicines and Healthcare products Regulatory Agency, the Central Alerting System and other relevant bodies, such as Public Health England.

We carried out this announced inspection on 14 November 2018 under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. We planned the inspection to check whether the registered provider was meeting the legal requirements in the Health and Social Care Act 2008 and associated regulations. The inspection was led by a CQC inspector who was supported by a specialist dental adviser.

To get to the heart of patients’ experiences of care and treatment, we always ask the following five questions:

• Is it safe?

• Is it effective?

• Is it caring?

• Is it responsive to people’s needs?

• Is it well-led?

These questions form the framework for the areas we look at during the inspection.

Our findings were:

Are services safe?

We found that this practice was not providing safe care in accordance with the relevant regulations.

Are services effective?

We found that this practice was providing effective care in accordance with the relevant regulations.

Are services caring?

We found that this practice was providing caring services in accordance with the relevant regulations.

Are services responsive?

We found that this practice was providing responsive care in accordance with the relevant regulations.

Are services well-led?

We found that this practice was not providing well-led care in accordance with the relevant regulations.

Background

Abbey Dental Care is in Glastonbury and provides private treatment to adults and children.

There is level access (via a portable ramp) for people who use wheelchairs and those with pushchairs. Car parking spaces, including for blue badge holders, are available near the practice.

The dental team includes the principal dentist, one associate dentist, two dental nurses, one dental hygienist, and one receptionist. The clinical team is supported by a practice manager and a receptionist. The practice has two treatment rooms.

The practice is owned by an individual who is the principal dentist there. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the practice is run.

On the day of inspection we collected 16 CQC comment cards filled in by patients and obtained the views of seven other patients.

During the inspection we spoke with the principal dentist, a dental nurse, the receptionist and the practice manager. We looked at practice policies and procedures and other records about how the service is managed.

The practice is open:

Monday to Wednesday 8am-6pm

Thursday 9am-6pm

Friday 8am-4pm

Our key findings were:

• The practice staff had suitable safeguarding processes and staff knew their responsibilities for safeguarding vulnerable adults and children. Improvements were required to ensure all staff had up-to-date training.
• The clinical staff provided patients’ care and treatment in line with current guidelines.
• Staff treated patients with dignity and respect and took care to protect their privacy and personal information.
• The appointment system met patients’ needs.
• The provider dealt with complaints positively and efficiently.
• The provider had suitable information governance arrangements.
• The practice required improvements to ensure that it was clean and well maintained.
• The practice had infection control procedures although we noted that the storage of dental instruments did not always reflect published guidance.
• The practice had staff recruitment procedures although improvements were required to ensure that documentation for each staff member reflected the information specified in Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.
• Staff knew how to deal with emergencies. Not all medicines and life-saving equipment were however available or in date.
• The practice had inadequate systems to help them manage risk to patients and staff.

We identified regulations the provider was not complying with. They must:

• Ensure care and treatment is provided in a safe way to patients.
• Establish effective systems and processes to ensure good governance in accordance with the fundamental standards of care.

Full details of the regulations the provider was not meeting are at the end of this report.

There were areas where the provider could make improvements. They should:

• Review the storage of dental care products and medicines requiring refrigeration to ensure they are stored in line with the manufacturer’s guidance and the fridge temperature is monitored and recorded.

• Review the practice’s systems in place for environmental cleaning taking into account current national guidelines.

• Review the practice’s arrangements for receiving and responding to patient safety alerts, recalls and rapid response reports issued by the Medicines and Healthcare products Regulatory Agency, the Central Alerting System and other relevant bodies, such as Public Health England.